Provider Demographics
NPI:1952586430
Name:SERC OF LANSING
Entity Type:Organization
Organization Name:SERC OF LANSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, ATC
Authorized Official - Phone:913-351-3838
Mailing Address - Street 1:1004 PROGRESS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-6326
Mailing Address - Country:US
Mailing Address - Phone:913-351-3838
Mailing Address - Fax:913-351-3939
Practice Address - Street 1:1004 PROGRESS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6326
Practice Address - Country:US
Practice Address - Phone:913-351-3838
Practice Address - Fax:913-351-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS39845014OtherBCBS
KS39845014OtherBCBS